Back Pain In Pregnancy - Understanding and Relieving Your Pain Safely
I had the chance last week to Skype with my brother and sister-in-law back in the United States - checking in on the family, how my nephew was doing in school, etc. Unfortunately, my sister-in-law could only chat for a few minutes before she had to go lie down for a while. See, she is VERY pregnant (39 weeks, 5 days at the time I wrote this) and feels a lot of pressure in the lower part of her pelvis. Unfortunately, this is not new, as she has been experiencing low back pain for the past few months which has been getting worse as the weeks have gone by and she now has trouble standing or sitting for any period of time.
This is a common pregnancy complaint, with over 60% of women reporting back pain at some point during their pregnancy. Certainly, with all the other symptoms women can experience during pregnancy (nausea, heartburn, fatigue, etc.), back pain is an unwelcome guest. However, there are some simple things that can be done to reduce pain and improve quality of life in pregnancy. First question to answer though is:
Why does pain develop during pregnancy?
During pregnancy, there are a lot of hormonal changes occurring (like I need to tell you that!). One specific hormone that increases is called Relaxin. The job of Relaxin is to help joints and supporting tissues relax and stretch out, allowing for a woman's pelvis to change shape, accommodating for the growing fetus and allowing passage of a newborn during birth. Without this hormone, the delivery process wouldn't be possible. However, not only does the pelvis start moving more, so does the spine. When this happens, joints that normally move together in very small increments now move independently of each other to large degrees, causing pain. Moreover, with the abdominal muscles stretched out and low back muscles struggling to keep a person upright, this imbalance can cause pain. Some of the areas in the low back that move excessively and contribute to experiences of pain/pressure are:
- Sacrum (base of spine)
- Coccyx (tailbone)
- Sacroiliac joint (between the sacrum and the pelvis)
- Lumbar (low back) muscles
- Lumbar joints
When these areas are affected, pain can develop in the lower back, across the base of the spine into the buttock, sides of the hips and even into the back of the thigh. True sciatica pain though, with symptoms developing into the lower leg, is a relatively rare occurrence.
Who develops back pain develop during pregnancy?
It can be very difficult to predict who is going to be a sufferer, however, some trends that have been observed amongst pregnant women with low back pain include:
• Strong link with back pain before pregnancy or back pain in previous pregnancy
• Higher number of previous pregnancies associated with higher risk of severe, prolonged pain
• The later pain occurs in pregnancy, the less severe pain experienced
• Younger age at time of pregnancy associated with increased pain
• No link between pain after pregnancy and type of delivery or use of epidural during labor
• No link between incidence of low back pain and age, height or weight of pregnant women
What can be done to avoid or prevent the pain from worsening?
Women are somewhat limited in medical treatments available during pregnancy, given the safety concerns for the growing fetus. Medications are restricted and X-rays are avoided. So using simple treatment methods that patients can incorporate into their daily life is very desirable. Here are some tips on how you can manage low back pain symptoms during pregnancy:
1. Maintain good posture – As the baby develops and abdominal size increases, the body's center of gravity shifts forward and women feel a sense of being pulled forward. Many times, women compensate by leaning backwards to keep an upright posture; but this will commonly lead to increased stress on the spine joints and muscles, causing pain. Focus on keeping good posture by:
• Standing up straight
• Keep shoulder back and relaxed
• Keep feet spread apart to maintain balance and support
• Don't lock your knees straight when standing, keep slightly bent
Correct posture is not only important with standing, but sitting as well. Use a chair with a high back that will support your spine. Add a small pillow or lumbar support for pain relief as needed when seated.
2. Proper Lifting – This applies to not only pregnant women, but to every person. There are two ways in which people typically will lift up objects on the ground: by bending at the knees or bending at the waist. ALWAYS bend at the knees!! When a person bends at the waist to lift a 20lb. box, it is equal to putting 100 pounds of force through the spine!! This is even more important in pregnancy, as there is increased pressure in the back from the strain of the fetus.
3. Sleeping Position & Surface – Try sleeping on your side (preferably the left), possibly with one or both knees bent up. Also, consider adding a pillow between the knees or abdomen for support. This can help to take pressure off the abdomen and spine joints, reducing muscle strain. Bear in mind that a firm mattress provides better support than soft. These are certainly in no short supply in China. Lastly, when getting out of bed, while lying on your side, bend up your knees and push yourself up to sitting with your arms. This puts the least stress on your back.
4. Heat/Cold Compress – These can be applied to the area of pain as needed for relief. Things to keep in mind: Heat is good for muscle tightness, Cold is good for inflammation. Never apply a heat or ice pack directly to the skin, cover it with a towel. Apply to the affected region for 20 minutes at a time. NEVER fall asleep with heat or ice in place: burns can occur this way.
5. Be active and stretch – Aerobic exercise, in the form of swimming, elliptical and stationary bike for 30 minutes, 3 times a week increases natural endorphin release, improves sleep, mood, energy, etc. Also, perform daily stretches at home for the lumbar spine and pelvis to reduce pain. Of course, consult your physician before starting any intense exercise or stretching routine.
6. Alternative treatments – There are many other forms of treatment available in China that are safe in pregnancy and can provide significant pain relief.
• Acupuncture – Research has been limited, but there is support for short-term relief during pregnancy.
• Massage – Good for relief of muscle spasm associated with low back pain.
• Pelvic support belts – Advocated by some groups, though the research does not demonstrate any significant pain relief.
• Chiropractor/Osteopath – Can treat muscle spasm through hands on therapy, as well as work to correct joint alignment; also, very important immediately following delivery to reduce incidence of prolonged low back pain issues post-partum.
When do you need to see a doctor?
Despite low back pain being a common occurrence during pregnancy, you should let your physician know whatever symptoms you are experiencing. While the most common reasons are related to increased strain in the muscles and joints, there can be other factors involved that your physician can screen for. Critically, prior to taking any medications to manage your pain, always consult with your physician. For the 10%-20% of women who continue to experience pain symptoms greater than 6 months after pregnancy, it is important to seek treatment early so as to avoid chronic pain symptoms. In the second part of this article next month, we will have a chance to discuss management of back pain after pregnancy.
FYI – I am the proud new uncle of Adam David Pfeifer, born April 19, 2012.
Congrats to my family back home!!
Dr. Ryan Pfeifer is a Rehab physician at IWS, focusing on minimally invasive, non-surgical management of neck and back pain. He is seeing patients full-time in Shanghai (clinics in Pudong and Puxi) and Guangzhou. For more information, please visit www.westernsurg.com. Dr Pfeifer has recently joined our panel of experts as pain management specialist.
Dr Pfeifer answered this expert question on practical ways and exercises you can do to strengthen your back during pregnancy.